Optimizing drug regimens and supplementation in orthognathic surgery: A comprehensive and practical guide.

OBJECTIVE: This study aimed to comprehensively review the literature and provide a practical guide for optimizing drug regimens and supplementation related to orthognathic surgery. METHODS: The authors conducted a thorough review of the existing literature, following the PRISMA-ScR guidelines. Various types of studies except case reports and reviews were included. The study applied specific inclusion criteria, focusing on perioperative and/or postoperative drugs, medications, or supplementation related to orthognathic surgery. RESULTS: This guide included 78 studies on various medications in orthognathic surgery. It encompasses clinical trials, cohort studies, cross-sectional studies, prospective and retrospective studies. The topics covered include antibiotics, analgesics, corticosteroids, antiemetics, hemostatic agents, local anesthetics, herbal medicine, and botulinum toxin. Pain and edema control involved specific medications, while local anesthesia utilized ropivacaine and bupivacaine. The guide also discusses mineral and vitamin supplementation. The effectiveness of hemostatic agents and antiemetics was highlighted. CONCLUSION: Pain management, reduced swelling, enhanced wound healing, and faster recovery are among the advantages. In addition to the standard drugs and medications, the inclusion of vitamin and mineral supplements, tranexamic acid, postoperative anesthetic blocks, and preemptive antiemetics is anticipated to offer various benefits in orthognathic surgery, despite the limited available evidence.

A viable method to replace the metal trocar drill guide in the inaccessibility of the long sagittal drill for mandibular fixation in BSSO.

The bilateral sagittal split osteotomy requires many specific instruments. Many of them are not used by any surgical team other than the maxillofacial surgery team. The absence of some of these materials makes it practically impossible to perform or continue the operation, with a negative impact on the outcome. The present report aims to discuss an alternative in cases where long drills for drilling mandibular sagittal osteotomies are not available. An inexpensive method, available in all surgical centers.

Mechanical Evaluation of Different Stable Internal Fixation Techniques of Sagittal Osteotomy in Mandibular Advance / Evaluación Mecánica de Diferentes Técnicas de Fijación Interna Estable de Osteotomía Sagital en Avance Mandibular

The mandibular advancements performed in orthognathic surgeries can be stabilized with several techniques when using stable internal fixation. This study aims to comparatively evaluate, in vitro, the mechanical strength in a polyurethane mandibular model for four fixation techniques for sagittal split ramus osteotomy mandibular. 60 samples were divided into 4 groups, with 15 units for each group: group A, group B, group C and group D. Advances of 5 mm were made for each subgroup and fixed with 2.0 mm system plates and monocortical screws in the replicas of human hemimandibles in polyurethane resin. The samples were submitted to mechanical tests of linear loading, being evaluated the peak load and peak deformation. Technique B presented higher peak load (Kgf) and techniques A and B presented higher peak strain (p<0.05). Technique D presented lower peak load and lower peak strain (p<0.05). It is concluded that the study based on the development of new techniques for fixation for sagittal osteotomy of the mandibular ramus is of great importance for the advancement of orthognathic surgery, provided by the technical innovation of more favorable plate models.

Los avances mandibulares realizados en cirugías ortognáticas pueden estabilizarse con varias técnicas cuando se utiliza fijación interna estable. Este estudio tuvo como objetivo evaluar comparativamente, in vitro, la resistencia mecánica en un modelo mandibular de poliuretano para cuatro técnicas de fijación para la osteotomía sagital de la rama mandibular. Se dividieron 60 muestras en 4 grupos, con 15 unidades para cada grupo: grupo A, grupo B, grupo C y grupo D. Se realizaron avances de 5 mm para cada subgrupo y se fijaron con placas de sistema de 2,0 mm y tornillos monocorticales en las réplicas de hemimandíbulas humanas en resina de poliuretano. Las muestras fueron sometidas a pruebas mecánicas de carga lineal, siendo evaluadas la carga máxima y la deformación máxima. La técnica B presentó mayor pico de carga (Kgf) y las técnicas A y B presentaron mayor pico de deformación (p<0,05). La técnica D presentó menor carga máxima y menor tensión máxima (p<0,05). Se concluye que el estudio basado en el desarrollo de nuevas técnicas de fijación para la osteotomía sagital de la rama mandibular es de gran importancia para el avance de la cirugía ortognática, proporcionada por la innovación técnica de modelos de placas más favorables.

New Treatment in Facial Nerve Palsy Caused by Sagittal Split Ramus Osteotomy of Mandible.

A 25-years-old woman with mandibular prognathism underwent a mandibular setback by way of mandibular sagittal split ramus osteotomy (MSSRO). After 2 days of operation, she developed difficulty of closing her right eye. The blink reflex test and motor nerve conduction study of the right orbicularis oris muscle were revealed right facial neuropathy of unknown origin and House-Brackmann facial nerve grading system (HBFNGS) grade V. For treatment, we initially prescribed oral prednisolone and nimodipine including physical therapy. The samples consisted of 11 facial nerve palsy patients caused by MSSRO and were analysed about onset of facial nerve palsy, postoperative HBFNGS, final HBFNGS, treatment method and recovery time. At 10 weeks of treatment of nimodipine, she had completely regained normal function (HBFNGS grade I) of the right facial nerve. The clinical results lead to assume a fast recovery of facial nerve function by the nimodipine medication, whereas average time of recovery is 16.32 weeks in references. Despite of the limited one patient treated, the result was very promising with respect to a faster recovery of the facial nerve function. Considering the use of nimodipine treatment for peripheral facial nerve palsy following a surgical approach with an anatomically preserved nerve can be recommended.